Assam Schedule III (Sec I.) Form No. 66.

LAST-PAY CERTIFICATE OF GAZETTED OFFICERS

Last Pay certificate of Mr. …………………………………………………………………………………………………..

of the ……………………………………………….……………………………………………………………………….….

proceeding on ………………………………………………………………………………………………………….…….

to ………………………………………………………………………………………………………………………………..

2. He has been paid up to __________________________________________________________________

at the following rates.

Particulars Rate

____________________________________________________________________________________________________

Additional pay for officiating ________________________________________________________________________

Exchange Compensation Allowance

____________________________________

____________________________________

Deductions

_____________________________________

_____________________________________

_____________________________________

3. His General Provident Fund Account No. is ________________________________________________

maintained by the Accountant General __________________________________________________

4. He made over charge of the office _______________________________________________________

____________________________________________________________________________________________________

on _______________________________________________ noon of _________________________________________

5. Recoveries are to be made from the pay of the Government servant as detailed on the
reverse. He has been paid salary as detailed below. Deductions have been made as noted
on the reverse.

Period

From ____________________________ to __________________________ Rs. _________________________ a month

From ____________________________ to __________________________ Rs. _________________________ a month

From ____________________________ to __________________________ Rs. _________________________ a month

7. He is entitled to draw the following.

8. He is also entitled to joining time for ……………………….. days.

9. He finance the insurance policies detailed below from the Provident Fund.

Name of the Insurance Company Name of Party Amount of Premium Due date for
Payment of Premium

10. The details of the income-tax recovered from him up to the date from beginning of the
current year are note on the service.

Date………………20 Treasury Officer

Accountant General, Assam

 DETAILS OF RECOVERIES

Nature of recovery _________________________________________________________________________________

Amount Rs. ________________________________________________________________________________________

to be recovered in ________________________________________ Installments.

Deductions made from leave salary

From ________________ to _________________ on account of _____________________ Rs. ___________________

From ________________ to _________________ on account of _____________________ Rs. ___________________

From ________________ to _________________ on account of _____________________ Rs. ___________________

Amount of
Gratuity Fees
Name of months Pay income-tax Remarks
etc.
record

April 20

May 20

June 20

July 20

August 20

September 20

October 20

November 20

December 20

January 20

February 20

March 20